City & Guilds Certificate & Diploma in Education and Training – Application Form Your details Which course date are you applying for? (Please state the date of the course): Date of application: Your name: Your title: Mr Miss Ms Mrs Your Age: Date of Birth (Minimum age 19): Nationality: British, Welsh, Irish, French etc. Home Address Line One: Home Address Line Two: Home Address Line Three: Postcode: Work telephone number: Mobile telephone number: Email Address: * Gender: Female Male Course fees Who is paying for your course fees? You Your employer Other Payment information If your employer/sponsor is paying the fees please give a contact details for the invoice and also give any relevant purchase order no. Payer / Employer's Name: Payer / Employer's contact name Payer / Employer's email address Payer / Employer's contact number Purchase order number About your teaching role How long have you been teaching / training? (Number of Years) Do you teach learners over the age of 14? Is your teaching to learners over the age of 14? IF NO please call us on 01246 237187 Yes No What is the geographical location of your teaching (town and county)? What subjects will you be teaching and what qualifications do you have in these subjects? Do you have English, Maths and IT qualifications / or experience at Level 2? Yes No Please state if you have any specific learning or physical requirements: Lunch and refreshments are provided; do you have any special dietary requirements? Personal statement (please ensure this statement is fully completed before submitting): * Personal Statement This is a vital part of our initial assessment process to support your application to undertake the AET qualification with Jade Solutions (UK) Ltd. Please complete a personal statement of at least 250 words to support your application. Explain who you are and what you want to gain from the course. To undertake this course you need to have subject specialist knowledge / qualifications at level 3 or above and ICT, English and numeracy skills equivalent to at least level 2. In your statement justify how you can demonstrate these skills. The statement must be well written and concise.